NCM 108: Health Care Ethics

Situational Analysis

Lague, Inah Krizia O. BSN 2A

1. A nursing student is taking part in a health fair in a community. She takes blood pressures with a
cuff that has not been calibrated in a long time. Despite this, she suggests that those with
borderline and high readings visit their family physicians. She also does simple checks for blood
sugar and makes referrals where indicated. She has no idea whether the machine has been
calibrated and what its margin of error is.
What is the health care professional’s duty with regard to the calibration of instruments?
Is it ethical to use a cuff that has not been calibrated for a long time? What harms can follow from
inaccurate test results? What are the professional’s responsibilities to individuals during such
screenings?

As a health care professional , it is truly their duty and responsibility to promote and
ensure accuracy in everything that they do and they must know what they are doing since patient
put their trust on them. They must be confident in every result that they could give to their patient
,and to be confident in the results being measured, there is an ongoing need to maintain the
calibration of equipment throughout its lifetime for reliable, accurate and repeatable
measurements. Being ethical involves weighing the potential consequences of one's actions .
Therefore, it is not ethical to use a cuff that has not been calibrated for a long time . I do believe
that inaccurate test results can make crucial medical decisions sometimes life or death calls based
on incorrect assumptions that patients have ailments that they probably don’t.

2. A doctor sees a 62-year-old male patient for a routine visit. The patient has no family history of
cancer. The physician does the physical examination and prostate exam that came out as normal.
He later on recommended that the patient will have a lipid panel, a colonoscopy, in which the
patient has never done, and a PSA (Prostate Specific Antigen) tested. The patient stated that he
heard of PSAs no longer being recommended for general screening, but the physician replies that
he has seen this recommendation change constantly. The doctor added that he even gets these
tests himself and feels that many in his practice have been cured as a result of this test.
Should the physician go against currently accepted guidelines? What if the test results in
a complication? What if he did not recommend it and the patient develop prostate cancer two
years later?

I do believe that there are times when a physician can justifiably make a
recommendation to a patient that contravenes a current clinical guideline. In making such a
 recommendation, the physician should communicate a rationale for deviating from clinical
guidelines and respect a patient’s autonomy. The need for and limitations of clinical guidelines,
numerous factors influencing shared decision making, and key ethical principles of
nonmaleficence and respect for patient autonomy must also be considered. The decision of the
patient is the only thing that will truly matter in the end. The role of the physician is to facilitate
the patient in making the decision with regards to his/her own health and to disseminate
necessary information.

3. As part of a nontherapeutic research, researchers intend to inject dead cancer cells into seriously
ill patients. There is no danger from the dead cancer cells other than the minimal danger of
infection at the injection site. They feel that if they reveal the nature of the injection, patients and
their surrogates will refuse consent, even leading to fear when they hear the word “cancer.” As a
result, the doctors do not reveal to their patients the nature of the injection on the consent form.
They justify this on the grounds that there is no real danger to the patients and that the research
is aimed at gaining knowledge.
Were the researchers ethical in suppressing the fact that they were using cancer cells?
Did they obtain informed consent from their subjects? What should they have done?

The studies were important and productive and should have been done, but that it was
unethical not to tell the subjects that they were receiving dead cancer cells instead of just “cells,”
as the experimenters had described the tests to the patients. They did obtained informed consent
from their subject however I cannot consider it as valid since some significant details were not
included, like the nature of the injection. To be valid, consent must be freely and voluntarily given
by a patient with capacity who has been given all the information he or she needs to reach a
decision. The most fundamental ethical principles implied in the treatment of the participants
should involve nonmaleficence , autonomy and fidelity.

4. A drug wants to test drug HQ as a relief for high blood pressure. Tests have shown that the drug
is not toxic in the doses required in the research protocol. Animal tests indicate that the drug has
fewer undesirable effects than the existing treatments. Drug HQ works by opening up the veins
and uses a chemical compound produced by the heart itself. It promises to be far superior to
present treatments because it uses a chemical that is found naturally in the body.
These, including the side effects, were explained to the prospective subjects, who
understand that they will be randomly assigned to one or two groups: one will receive drug HQ
and another will receive an accepted treatment. They were also informed that it will be a double
blind experiment.
The results show that drug HQ is more effective than the accepted treatment and has
fewer side effects, but the significance of this is not clear, since the probability that the difference
is due to chance is less than 10 percent and the researchers had originally decided on 5% as the
cutoff figure. Despite this, they publish an article concealing the differences in probabilities by
simply not mentioning it.
 Is It ethical to hide a key bit of information that would aid in interpreting the results? Are
further tests needed to see if the drug meets the requirements? What is the utility of publishing
studies with negative results?

In Research involving human subjects, risks posed to subjects should be acceptable and
the information describing risks and benefits of subject participation should be conveyed to
subjects in an accurate and intelligible manner. It is truly not ethical to hide a key bit of information
that would aid in interpreting the results and I do agree that further tests are needed to see if the
drug meets the requirements. On the other hand, studies with negative results don’t mean
absence of information. If your experimental design was sound, your analysis was well done
and capable of sufficient discrimination to produce results you have confidence in, then yes
there is value in such negative results. Publishing them may well keep someone else from
wasting time on the same or very similar experiments.